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HIPAA: Standardized National Code Sets

HIPAA establishes standard code sets for transactions. These standard code sets include National Drug Codes (NDCs), International Classification of Diseases Clinical Modification and Procedure Coding System (ICD-10-CM/PCS) for diagnoses and inpatient hospital procedures, Current Procedural Terminology, 4th Edition (CPT-4), Current Dental Terminology (CDT) and the Healthcare Common Procedure Coding System (HCPCS). All state-only and proprietary codes are disallowed for use under the HIPAA regulations.

The Department of Health Care Services is currently reviewing their state-only and proprietary codes and will notify providers of any future changes. There are additional standardization requirements for unique identifiers and security that have not yet been finalized by the Department of Health and Human Services and may have significant impact to your organization.

Below is a list of the approved national codes.

Codes Standards
Diagnosis codes ICD-10-CM
Physician services CPT-4 (HCPCS level I)
Dental services CDT-3
Inpatient hospital services ICD-10-PCS
Other health-related services Alpha-numeric HCPCS
Drugs NDC
Other substance, equipment and misc. health care items Alpha-numeric HCPCS